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2. Please update any contact information that is pertinent to your Bluffdale Utility Account.
5. First Name
6. Last Name
7. Service Address*
9. Mailing Address*
10. City*
11. State*
12. Zip Code*
14. Updating my: *
    -- Select One --Phone NumberMailing AddressEmailProperty Management ContactName Change

    Any information needing updated

15. Phone Number (Old)
16. Phone Number (New)*

    *Only used to contact you for either a Water issue or Past due account*

18. Property Management Contact

    Name, Email and Phone Number of who is over the Account

20. Email (Old)

    If you want to remove it.

21. Email (New)*

    *Only used to contact you for either a Water issue or Past due account*

23. Comments:
25. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.

27. Governmental entities must obtain and process only the minimum amount of personal data reasonably necessary to efficiently achieve a specified purpose, retained for required period. Utah Code § 63A-19-401(2)(c)

29. Electronic Signature*
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field